Provider Demographics
NPI:1396731568
Name:INTERNAL MEDICINE & CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:INTERNAL MEDICINE & CARDIOLOGY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-679-5911
Mailing Address - Street 1:1565 N MAIN ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2972
Mailing Address - Country:US
Mailing Address - Phone:508-679-5911
Mailing Address - Fax:508-324-7605
Practice Address - Street 1:1565 N MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-679-5911
Practice Address - Fax:508-324-7605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9707204Medicaid
MA9707204Medicaid
MAM12095Medicare PIN